Anemia of prematurity : time for a change in transfusion management?

Abstract

In this thesis we investigated clinical effects of allogeneic red blood cell (RBC) transfusions in premature infants, different transfusion volumes in relation to neonatal outcome in premature infants and the use of autologous cord blood (CB) as an alternative for allogeneic transfusions. Despite the use of a national transfusion guideline, we observed significant differences concerning the total amount of administered transfusions. A liberal transfusion strategy and a higher transfusion volume was not associated with poor short-term outcome, nor delayed neuro-motor development at the age of 2 years. CB-RBC products had a shelf-life of 14-21 days. We showed in a clinical trial that premature infants born <30 gestational weeks suffering from anemia of prematurity can be treated with autologous CB-RBCs. CB derived CD34+stem cells provide a potential source for expanded RBCs for autologous use. However, culture protocols should be optimized for clinical use. Currently, clinical studies are focusing on more restrictive neonatal transfusion practice. Use of autologous CB can assist in reducing allogeneic transfusions. However, much remains to be done before this can be achieved. Until then, the presumed disadvantages of allogeneic RBCs on neonatal outcome should be further clarified, because avoidance of these transfusions is unattainable in current clinical practice.